Healthcare Provider Details

I. General information

NPI: 1821752973
Provider Name (Legal Business Name): KIMBERLY LISA EYRAUD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2021
Last Update Date: 11/12/2021
Certification Date: 10/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 N LITCHFIELD RD
GOODYEAR AZ
85395-1237
US

IV. Provider business mailing address

1515 N LITCHFIELD RD
GOODYEAR AZ
85395-1237
US

V. Phone/Fax

Practice location:
  • Phone: 623-935-3233
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS025531
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: